Instrument insertion system, method, and apparatus for performing medical procedures

ABSTRACT

In some embodiments, an insertion device for a single port robotic surgery apparatus includes a plurality of instrument channels positioned in an interior of a housing and extending along substantially an entire length of the housing, the plurality of instrument channels configured to removably house a plurality of surgical instruments, a plurality of openings in a rear exterior surface of the housing, the plurality of openings providing access to the plurality of instrument channels and configured to facilitate insertion of the plurality of surgical instruments into the plurality of instrument channels, and an illumination device supported at least partially at the rear exterior surface of the housing and positioned proximal to the plurality of openings, the illumination device configured to illuminate the openings to facilitate insertion of the plurality of instruments through the plurality of openings.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation in part Continuation Applicationswhich claims the benefit of and priority to U.S. patent application Ser.No. 16/299,834, filed on Mar. 12, 2019, now U.S. Pat. No. 11,109,746,which is a Continuation-in-Part Application of each of U.S. patentapplication Ser. No. 16/156,651, now U.S. Pat. No. 10,624,532, and U.S.patent application Ser. No. 16/156,625, now U.S. Pat. No. 10,398,287,both of which were filed on Oct. 10, 2018, the disclosure of each ofwhich being incorporated by reference in their entirety.

TECHNICAL FIELD

This disclosure relates generally to positioning one or more instrumentsand more particularly to positioning one or more instruments inside abody cavity of a patient for performing a medical procedure.

DESCRIPTION OF RELATED ART

Surgical instruments are used during investigative medical proceduresand surgical procedures, such as laparoscopic surgery and computerassisted robotic surgery, to facilitate performing a procedure within abody cavity of the patient. Known instrument insertion systems sufferfrom a variety of shortcomings, including difficulties with use in thefield, lack of reliability, and the like. The present disclosureovercomes these and other problems associated with known instrumentinsertion systems, methods, and apparatuses.

SUMMARY

In some cases, an insertion device for a single port robotic surgeryapparatus includes a housing. The housing can include a plurality ofinstrument channels positioned in an interior of the housing andextending along substantially an entire length of the housing, theplurality of instrument channels configured to removably house aplurality of surgical instruments, a plurality of openings in a rearexterior surface of the housing, the plurality of openings providingaccess to the plurality of instrument channels and configured tofacilitate insertion of the plurality of surgical instruments into theplurality of instrument channels, and an illumination device supportedat least partially at the rear exterior surface of the housing andpositioned proximal to the plurality of openings, the illuminationdevice configured to illuminate the openings to facilitate insertion ofthe plurality of instruments through the plurality of openings.

The insertion device of any of preceding paragraphs and/or any ofinsertion devices described below can include one or more of thefollowing features. The illumination device can be positioned in arecess in the rear exterior surface of the housing. The recess can bepositioned above the plurality of openings. The insertion device canfurther include a seal covering the plurality of openings and a closurecovering the seal and preventing the seal from being dislodged. The sealcan be configured to prevent ingress of fluids or solids into theplurality of openings. The closure can include substantially transparentmaterial that permits viewing of the plurality of openings whenillumination is provided by the illumination device. The closure caninclude a plurality of openings configured to permit access to aplurality of openings in the seal, each of the plurality of openings inthe closure being tapered toward the plurality of openings proximal tothe plurality of openings in the seal. Each of the plurality of openingsin the closure can include a proximal end with a larger opening than anopening in the distal end. The closure can be removable to facilitateremoval and replacement of the seal. The closure can be removablyfastened to the housing. The closure can include a latch.

The insertion device of any of preceding paragraphs and/or any ofinsertion devices described below can include one or more of thefollowing features. The housing can further include a camera channelenclosing a camera and a light source configured to provide illuminationfor the camera. The light source can include at least one of an opticalfiber or a light emitting diode (LED). The illumination device canutilize the light source. The illumination device can include a lightsource separate from the light source configured to provide illuminationfor the camera. The separate light source can include an LED positionedin a recess in the housing.

Any of the insertion and/or visualization devices of any of precedingparagraphs and/or described below can be used with any of insertiondevices, visualization devices, and/or robotic surgery systems describedherein.

In some cases, an insertion device for a single port robotic surgeryapparatus includes a housing. The housing can include a plurality ofinstrument channels positioned in an interior of the housing andextending along substantially an entire length of the housing, theplurality of instrument channels configured to removably house aplurality of surgical instruments, a plurality of openings in anexterior surface of the housing, the plurality of openings providingaccess to the plurality of instrument channels and configured tofacilitate insertion of the plurality of surgical instruments into theplurality of instrument channels, and a seal covering the plurality ofopenings and configured to prevent ingress of fluids or solids into theopenings, the seal including a plurality of ports, each of the portscovering a respective opening of the plurality of openings.

The insertion device of any of preceding paragraphs and/or any ofinsertion devices described below can include one or more of thefollowing features. Plurality of ports can include first and secondports proximal to each other, and wherein the first and second ports atleast partially overlap. The first port can include a first valve, andthe second port can include a second valve. Each of the first and secondports can include a proximal end and a distal end positioned proximal toan opening of a respective instrument channel, and wherein the proximalends of the first and second ports at least partially overlap. Each ofthe first and second ports can be tapered toward the distal end. Theseal can be removable.

The insertion device of any of preceding paragraphs and/or any ofinsertion devices described below can include one or more of thefollowing features. The insertion device can include a closure coveringthe seal and preventing the seal from being dislodged. The closure canbe removable to permit removal and replacement of the seal. The closurecan be removably attached to the housing. The closure can include alatch.

Any of the insertion and/or visualization devices of any of precedingparagraphs and/or described below can be used with any of insertiondevices, visualization devices, or robotic surgery systems describedherein.

In some cases, a method of using and/or operating a robotic surgeryapparatus can include attaching an insertion device to a mountinginterface of a robotic surgery apparatus. The method can includeinserting at least one instrument into an instrument channel of theinsertion device, as described in any of preceding paragraphs or below.The opening of the instrument channel and/or the instrument channel canbe illuminated to facilitate insertion of the at least one instrument.The method can be at least partially performed by a user, such as anurse, surgeon, or the like.

In some cases, a method of using and/or operating a robotic surgeryapparatus can include removing and/or replacing one or more seals of aninsertion device, as described in any of preceding paragraphs or below.The one or more seals can include a seal covering an opening associatedwith at least one instrument channel of the insertion device. The methodcan be at least partially performed by a user, such as a nurse, surgeon,or the like.

In some cases, a method of using and/or operating a robotic surgeryapparatus as described and/or illustrated is provided. In some cases, amethod of using and/or operating a visualization device as describedand/or illustrated is provided. In some cases, a method of using and/oroperating an insertion device as described and/or illustrated isprovided.

Any of the methods of any of preceding paragraphs and/or described belowcan be used with any of insertion devices, visualization devices, orrobotic surgery systems and/or any of the methods of operating and/orusing such devices and/or systems described herein.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the present disclosure will now be described hereinafter,by way of example only, with reference to the accompanying drawings inwhich:

FIG. 1A illustrates a robotic surgery system in accordance with someembodiments;

FIG. 1B illustrates a patient cart of a robotic surgery system accordingto some embodiments;

FIGS. 2A-2B illustrate insertion and visualization devices according tosome embodiments;

FIGS. 3A-3E illustrate an insertion device according to someembodiments;

FIGS. 3F-3H illustrate a seal of an insertion device according to someembodiments;

FIG. 3I illustrates a rear view of a drive unit of a robotic surgerysystem according to some embodiments;

FIGS. 3J-3K illustrate rear views of an insertion device according tosome embodiments;

FIGS. 4A-4C illustrate a visualization device according to someembodiments;

FIGS. 5A-5E illustrate a mounting interface of a drive unit of a roboticsurgery system according to some embodiments;

FIGS. 6A-6I illustrate attachment of insertion and visualization devicesto a mounting interface of a drive unit of a robotic surgery systemaccording to some embodiments;

FIGS. 7A-7H and 8 illustrate visualization devices with imagersaccording to some embodiments;

FIGS. 9A-9B and 10A-10B illustrate visualization and/or insertiondevices according to some embodiments;

FIGS. 11 and 12A-12D illustrate drive units of a robotic surgery systemaccording to some embodiments.

DETAILED DESCRIPTION

Overview

When performing medical procedures (for example, with assistance ofsurgery using a robotic surgical system) one or more instruments can beinserted into a body cavity of a patient. The insertion process has somerisk since instruments may inadvertently damage organs or tissue whilebeing inserted. Incorrect positioning of the one or more instruments inthe body cavity may also result in a limited range of motion within thebody cavity.

As an example, when performing abdominal surgery, at least one incisionwould be made in a body wall of the patient's abdomen. A trocar or otheraccess port, may then be inserted through the incision. A camera can befirst inserted through the access port and used by a surgeon to captureand relay stereoscopic images of a surgical site. One or moreinstruments can be inserted following the camera insertion. Viewsprovided by the camera facilitate insertion of the one or moreinstruments and their manipulation of the surgical site.

Referring to FIG. 1A, a robotic surgery system in accordance with someembodiments is shown generally at 100. In some implementations, therobotic surgery system 100 can be configured to facilitate a medicalprocedure performed via a single incision. A single access port can beinserted into the incision to provide access for one or more instrumentsand cameras.

The system 100 can include a workstation 102 and a patient cart 104,which is illustrated in more detail in FIG. 1B. The patient cart 104 caninclude a central unit or drive unit 106 to which instrument insertionand visualization devices 108 can be attached or mounted. Theworkstation 102 can include an input device 112 that receives operatorinput and produces input signals and may also be configured to generatefeedback to the operator. The feedback can be visual, auditory, haptic,or the like. The input device 112 can be implemented using a hapticinterface available from Force Dimension, of Switzerland, for example.

The workstation 102 can further include a master processor circuit 114in communication with the input device 112 for receiving the inputsignals and generating control signals for controlling the roboticsurgery system, which can be transmitted to the patient cart 104 via aninterface cable 116. In some cases, transmission can be wireless andinterface cable 116 may not be present. The input device 112 can includeright and left hand controllers 122 and 124, which are configured to begrasped by the operator's hands and moved to produce input signals atthe input device 112. The patient cart 104 can include a slave processorcircuit 118 that receives and the control signals from the masterprocessor circuit 114 and produces slave control signals operable tocontrol the instrument insertion and visualization devices 108 and oneor more instruments (and their respective end effectors) during asurgical procedure. The one or more instruments can include dexteroustools, such as grippers, needle drivers, staplers, dissectors, cutters,hooks, graspers, scissors, coagulators, irrigators, suction devices,that are used for performing a surgical procedure. While both master andslave processor circuits are illustrated, in other embodiments a singleprocessor circuit may be used to perform both master and slavefunctions. The workstation 102 can also include a user interface, suchas a display 120 in communication with the master processor circuit 114for displaying information (such as, body cavity images) for a region orsite of interest (for example, a surgical site, a body cavity, or thelike) and other information to an operator. The workstation 102 can alsoinclude one or more controllers, such as one or more pedals 126, forcontrolling the robotic surgery system. For example, one or more pedals126 can include a clutch pedal that allows repositioning one or morecontrollers 122 or 124 without corresponding movement of the associatedinstrument.

Referring to FIG. 2A, in some embodiments, insertion and visualizationdevices 108 can include an insertion device 210 and a visualizationdevice 220. The insertion device 210 can include a housing 212 and aplurality of passages, lumens, or channels 214 for inserting and guidingone or more instruments. The plurality of channels 214 can be enclosedin another housing. The two housings can be connected. As isillustrated, the plurality of channels, such as radial channels, can beformed within a housing, which can be radially shaped. The plurality ofchannels 214 can also permit insertion of a camera lumen, cable,elongate shaft, or tube 224. As is illustrated, a distal end 224B of thecamera tube can extend beyond the housing including the plurality ofchannels 214. At least a portion of the distal end 224B can bepositioned near or in the site of interest. One or more cameras can bepositioned at the distal end 224B. The camera tube 224 can also includea proximal end 224A as described herein. In some embodiments, a channelof the plurality of channels 214 can house or support a camera inaddition to or instead of the one or more cameras of the camera tube224.

The visualization device can include a housing 222 to which the proximalend 224A of the camera tube can be removably (or non-removably)attached. The housing 222 can include an opening in which a one or moredrivers, such as at least one of 232A or 232B, can be positioned. Asdescribed herein, the one or more drivers can move the camera tube 224through the opening in the housing 222 and a channel of the plurality ofchannels 214 so that the distal end 224B extends away from one or moreof the housings 212 or 222 or retracts back toward or into one or moreof the housings 212 or 222. The camera tube 224 can form a loop aroundat least a portion of the housing 222 as illustrated in FIGS. 2A-2B. Thediameter of the loop can be increased when the distal end 224B isretracted toward or into one or more of the housings 212 or 222 and bedecreased when the distal end 224B is extended away from one or more ofthe housings 212 or 222. With reference to FIG. 2B, for example, whenthe distal end 224B is substantially fully retracted, the loop can havea diameter 262 as shown. When the distal end 224B is being extended awayfrom the one or more of the housings 212 or 222, the diameter 264 of theloop decreases as compared to the diameter 264 of the loop. When thedistal end 224B if fully extended away from the one or more of thehousings 212 or 222, the diameter 268 of the loop can be smaller thanthe diameters 262 and 264. In some cases, extending the distal end 224Baway from the one or more of the housings 212 or 222 causes the lengthof the proximal end 224A to decrease, which leads to a decrease in thediameter of the loop.

One or more cables 240 can be used to transmit control signals and data,such as analog or digital image data provided by the one or more cameraspositioned at the distal end 224B or in the insertion device 210, to thepatient cart 104. In some cases, transmission can be wireless and one ormore cables 240 may not be present.

At least a portion of the camera tube 224 can be flexible orsubstantially flexible in order to form a loop and/or be guided throughthe one or more openings and/or channels are described herein. In somecases, looping the camera tube 224 upward around at least the portion ofthe housing 222 as described can permit the camera tube to havesufficient length for reaching near and/or into the site of interest,while eliminating or reducing the risk of the camera tube 224 cominginto contact with non-sterile object, such as the floor.

Insertion Device

FIG. 3A illustrates a front perspective view of the insertion device 210according to some embodiments. The housing 212 of the insertion devicecan include an opening 330 configured (for example, sized and/or shaped)to permit the camera tube 224 to pass through the housing 212. Theopening 330 can include a seal, which may be covered by a closure (suchas a latch), to prevent ingress of fluid, gas, or solids into theinsertion device 210 and/or prevent backflow of fluid, gas, or solidsfrom the insertion device. Any of the seals described herein can includeone or more valves, such as a duckbill valve. As illustrated in FIG. 3Eshowing a cross-section view of the insertion device 210, the housing212 can include an interior passage 322 connecting the opening 330 to achannel 320 configured (for example, sized and/or shaped) to permit thecamera tube 224 to pass through the channel. The interior passage 322can be a channel positioned in an interior of the housing. The interiorpassage 322 can be bent or curved to facilitate various positionalconfigurations of the visualization device 220 with respect to theinsertion device 210 and in particular the housing 222 with respect tohousing 212. The interior passage 322 can include an opening that alignswith or includes the opening 300 and another opening that aligns with orincludes opening of the channel 320. In some cases, sealing material canbe used on or around the interior passage 322 in addition to or insteadof the seal in the opening 330. As illustrated in FIG. 2A, the distalend 224B of the camera tube 224 can exit the channel 320 and extend awayfrom the insertion device 210 toward a site of interest, such as asurgical site, body cavity, wound, or the like. Also, the distal end224B of the camera tube 224 can retract toward or into the channel 320toward the insertion device 210 and away from the site of interest.

The plurality of channels 214 can include one or more instrumentchannels 340 configured (for example, sized and/or shaped) to permit oneor more instruments to pass through and extend away from the insertiondevice 210 toward the site of interest. As is illustrated, there can betwo channels for left and right instruments.

In some cases, the interior passage 322 includes at least a portion witha central axis parallel to a central axis of the one or more instrumentchannels 340. The interior passage 322 can include at least a portion(for example, the curved portion illustrated in FIG. 3E) with a centralaxis not parallel to a central axis of the one or more instrumentchannels 340.

The plurality of channels 214 can include a channel 310 for one or morecameras of the insertion device 210. In some implementations, a cameracan be positioned at a distal end of the plurality of channels (or at ornear position of the arrow 310). Such one or more cameras (which can bereferred to as a secondary camera) can facilitate positioning adjacentto or insertion into the site of interest of at least one of one or moreinstruments or at least one of the one or more cameras of thevisualization device 220 (such cameras can be referred to as a primarycamera). The secondary camera can include a substantially flexible orsubstantially rigid lumen, cable, or elongate shaft that is insertedinto the channel 310. The secondary camera can be integrated with theinsertion device 210 or be removable. An opening of the channel 310 caninclude one or more seals, which may be covered by a closure (such as alatch), to prevent ingress of fluid, gas, or solids. In some cases,sealing material can be used on or around the opening of the channel 310in addition to or instead of the seal(s) in the opening.

With reference to FIG. 3D, a secondary camera 324 can include asubstantially flexible or rigid cable with a proximal end 324A and adistal end 324B. The distal end 324B can include a protector 370 (suchas glass or plastic). The protector 370 can protect an imager and/orother components of the secondary camera breaking or malfunctions dueto, for example, coming into contact with fluid in the site of interest.In other embodiments, a protector may be included as part of theinsertion device 210 at a distal end of the channel 310, and accordinglythe protector 370 may be optional. The secondary camera can include oneor more lenses that focus light from and/or reflected by at least theportion of the site of interest on an image sensor 384. The image sensorcan be positioned at the proximal end 324A and/or distal end 324B. Theone or more lenses can include concave and/or convex lenses. In somecases, one or more lenses can be moved to adjust the zoom (such as, anoptical zoom). The image sensor 384 can detect the light and convert itto image information or data. For instance, the image sensor 384 canmeasure brightness at a plurality of points. The image sensor 384 caninclude at least one of charge-coupled devices (CCDs), complementarymetal-oxide-semiconductor (CMOS) image sensors, or the like. The imagesensor 384 can be a digital and/or analog image sensor. In someimplementations, the secondary camera can include two or more cameras(for example, to produce a stereoscopic image).

In some cases, the secondary camera 324 can include an optical system382 that redirects the detected light. For example, the optical system382 can be a prism that redirects the detected light down onto the imagesensor 384. The image sensor 384 can be positioned in a different planethan a portion of the surgical site being imaged. The optical system 382may be omitted in some implementations. For example, the optical system382 may be omitted when the image sensor is positioned in the same planeas the surgical site being imaged.

The secondary camera 324 can be removable. For example, the secondarycamera cable can be inserted into and/or removed from the channel 310.When the secondary camera cable is removed, the channel 310 can be usedfor one or more of suction or irrigation of the site of interest. Thechannel 310 can alternatively or additionally be used to permit aninstrument (such as, third instrument) to be inserted. The instrumentcan be controlled by the robotic surgery system or manually by a user. Aprotector would not be included at a distal end of the channel 310 orwould otherwise be removable when the channel 310 is used for one ormore of aspiration, irrigation, instrument manipulation, or the like.

In some cases, the primary camera can be a stereo or stereoscopiccamera, which can produce three-dimensional representation of at least aportion of the site of interest, and the secondary camera can be atwo-dimensional camera. The secondary camera can have lower resolutionthan the primary camera. For example, the secondary camera can have1920×1080 pixels (or 1080p) resolution. The primary camera can haveresolution of 1080p, 4K, 8K, or the like. The channel 310 for thesecondary camera can be smaller in size (such as, narrower or havingsmaller diameter) than the channel 320 for the primary camera. Thesecondary camera may also include an illumination source or device forilluminating the site of interest. The illumination device can beincorporated as part of the secondary camera such that the illuminationdevice and a lens system of the secondary camera all fit within thediameter of the channel 310. In some cases, the illumination device caninclude optical fiber(s). For example, the illumination device can be anannular system with strands of fiber wrapping around a lens system sothat illumination is provided to the site of interest, for instance,using known means of fiber illumination.

In some cases, close proximity of the instrument channels 340 to one ormore camera channels 310 or 320 can facilitate single port surgery.

The housing 212 can include one or more attachment mechanisms 360. Forexample, the one or more attachment mechanisms 360 can be buttonspositioned on opposite sides of the housing 212. The buttons can beconfigured to removably attach the insertion device 210 to a mountinginterface of the drive unit 106 (or, in some cases, additionally oralternatively to the housing 222 of the visualization device 220).Pushing the buttons can release the insertion device 210 from themounting interface (and/or the housing 222 of the visualization device220). The one or more attachment mechanisms 360 can permit attachment toand release of the insertion device 210 from supporting pins of themounting interface (and/or the housing 222).

FIG. 3B illustrates a rear perspective view of the insertion device 210according to some embodiments. Openings of the one or more instrumentchannels 340 can include one or more seals, which may be covered by aclosure (such as a latch), to prevent ingress of fluid, gas, or solids.In some cases, sealing material can be used on or around at least one ofthe one or more openings of the one or more instrument channels 340 inaddition to or instead of the seal(s) in the one or more openings. Thehousing 212 can include one or more openings 350 for receiving one ormore supporting rods of pins, which can be positioned on the mountinginterface. The one or more attachment mechanisms 360 can permitattachment to and release of the insertion device 210 from thesupporting pins (and/or from the visualization device 220). For example,the one or more attachment mechanisms 360 can activate or release alatch or lock, such as a cam lock, cam lock with a spring, or the like.

FIG. 3C illustrates a rear perspective view of the insertion device 210showing seals 392 and 396 according to some embodiments. As describedherein, the opening 330 (through which the camera tube 224 is insertedas described herein) can be covered by a seal 396 held in place by aclosure 398, which can be a latch, clip, or the like. The seal 396 canprevent ingress of fluid, gas, or solids into the interior portion ofthe insertion device 210 and/or prevent backflow of fluid, gas, orsolids from the insertion device 210. The seal 396 can include a valve,such as a duckbill valve. The closure 398 can be removably fastened tothe housing 212 of the insertion device 210 in order to provide accessto the seal 396, allowing the seal 396 to be cleaned and/or replacedduring the same surgical procedure of between surgical procedures (suchas, when the insertion device 210 is being cleaned and/or sterilized).The closure 398 can be removably fastened to the housing 212 by aprotrusion or latch 397 of the closure 398 releasably engaging thebottom of a protrusion or projection 399 of the housing 212. In FIG. 3C,the closure 398 is illustrated in an open configuration or mode in orderto show the seal 396. In operation, the seal 396 is inserted into theopening 330 and the closure 398 is fastened to the housing 212 in orderto hold the seal 396 in place. FIG. 3B illustrates the closure 398 in aclosed configuration.

One or more openings in the one or more instrument channels 340 throughwhich the instruments are inserted can be covered by a seal 392 held inplace by a closure 394, which can be a latch, clip, or the like. Theseal 392 can prevent ingress of fluid, gas, or solids into the interiorportion of the insertion device 210 and/or prevent backflow of fluid,gas, or solids from the insertion device 210. The closure 394 can beremovably fastened to the housing 212 of the insertion device 210similarly to the closure 398. The closure 394 can provide access to theseal 392, which can be removed and/or replaced during the same surgicalprocedure of between surgical procedures (such as, when the insertiondevice 210 is being cleaned and/or sterilized). In FIG. 3C, the closure394 is illustrated in an open configuration or mode in order to show theseal 392. In operation, the seal 392 is inserted into the one or moreopenings of the one or more instrument channels 340 (see FIG. 3K) andthe closure 394 is fastened to the housing 212 in order to hold the seal392 in place. FIG. 3B illustrates the closures 394 in a closedconfiguration. One or more of the seals 392, 396 or the closures 394,398 can be disposable and/or replaceable.

As illustrated in FIGS. 3B and 3C, the closure 398 includes an openingthat coincides with the opening 330, and the closure 394 includes one ormore openings that coincide with the one or more openings in the one ormore instrument channels 340.

In some cases, as illustrated in FIG. 3C, a single seal 392 can coverboth openings of the one or more instrument channels 340. Although itthis can be preferable to using separate seals because of the closepositioning of the one or more openings of the one or more instrumentchannels 340 relative to one another, in some instances, the seal 392can include a plurality of separate seals. As illustrated in FIG. 3F(top view), 3G (bottom view view), and 3H (perspective view), the singleseal 392 can include two ports which are sized and shaped to cover theone or more openings in the one or more instrument channels 340. Theports 352 can include openings in the body of the seal 392 andprotruding portions. For example, the ports 352 can be valves, such asduckbill valves, as shown in FIGS. 3F-3H. Each of the ports 352 can beshaped as a funnel (as described herein), which can facilitate insertionof the instruments.

In some cases, due to the proximity of the one or more openings of theone or more instrument channels 340 to each other, the ports 352 of thesingle seal 392 can also positioned close to each other. Such closeproximity can cause the ports 352 to at least partially overlap asillustrated by a region 356 in FIG. 3F (top/rear view) and 3G(bottom/front view). The ports 352 can at least partially overlap on oneor more of top surface of the single seal 392 (FIG. 3F) or bottomsurface of the single seal 392 (FIG. 3G), which faces the one or moreopenings of the one or more instrument channels 340. For example, asillustrated in FIGS. 3F-3H, a port 352 can have a concave shape (orfunnel shape) that tapers from a distal end toward a distal end that ispositioned distal to and/or is inserted into an opening of the one ormore instrument channels 340. As shown in FIGS. 3F-3H, the proximal endsof the ports 352 can overlap (on one or more of top or bottom surfacesof the single seal 392) in the region 356. For instance, the proximalends of the ports can be circular or round, and the circles can overlapin the region 356, as illustrated in FIGS. 3F-3H. In some cases, theoverlap can be smaller or larger than that illustrated in the region356. In some instances, the ports 352 do not overlap. FIG. 31illustrates a rear view of the drive unit 106 showing loading of one ormore instruments 364 into the insertion device 210. Loading of aninstrument 364 can involve inserting a tip 366 of the instrument into anopening of a corresponding instrument channel 340. As is illustrated, auser may experience difficulties with the insertion of an instrument dueto, among others, close proximity of the openings of the one or moreinstrument channels 340 to each other, having to facilitate theinsertion through the rear of the drive unit 106 where light may belacking, or the like.

To facilitate insertion of the one or more instruments, one or moreopenings in the one or more instrument channels 340 can be illuminated.Referring to FIG. 3J, which illustrates a rear view of the insertiondevice 210, in some cases, an illumination device 362 can be supportedby the housing 212. The illumination device 362 can be positioned in arecess in the housing 212. For example, the illumination device 362 canbe positioned in a recess 365 shown in the cross-sectional view of thehousing 212 illustrated in FIG. 3K. The illumination device can 362 caninclude one or more light sources, such as one or more light emittingdiodes (LEDs) or optical fibers (combined with a remotely located lightsource), that emit light. In some cases, the illumination device 362 canilluminate one or more of opening(s) in the closure 394, one or moreports 352 in the seal 392, or one or more of the openings in the one ormore instrument channels 340. Such illumination can facilitate insertionof one or more instruments into the insertion device 210. The one ormore light sources can be covered by one or more of a protective cover,lens (which can also serve as a protective cover), or the like.

FIG. 3J illustrates the illumination device 362 positioned above one ormore openings of the one or more instrument channels 340. In someinstances, the illumination device 362 can be positioned on the bottom,on a side, or the like on the rear of the housing 212. In some cases,multiple illumination devices can be supported by the housing 212. Suchmultiple illumination devices can be positioned on same or differentsides of the rear of the housing 212. For example, two illuminationdevices can each be positioned above a respective instrument channelopening. In some cases, an illumination device can be positioned at theopening of an instrument channel 340 or inside the instrument channel340.

In some cases, the closure 394 can be made at least partially fromtransparent or substantially transparent material so that light emittedby the illumination device 362 passes through the closure 394 andilluminates the one or more openings of the one or more instrumentchannels 340. In some cases, the closure 394 can at least partiallycover the illumination device 362 (as shown in FIGS. 3J-3K).Alternatively or additionally, the closure 394 can include an opening orrecess so that the illumination device 362 is at least partially notcovered by the closure 394 so that at least some of the emitted lightdoes not pass through the closure 394. FIG. 3J illustrates a transparentor substantially transparent closure 394 as the seal 392 is visiblethrough the closure. In some cases, the illumination device 362 mayinclude a plurality of illumination devices or be shaped to contact alarger area of the closure 394.

As described herein, the illumination device 362 can include one or morelight sources, such as LEDs. In some cases, the illumination device 362can alternatively or additionally utilize one or more light sourcesalready present in or incorporated into the insertion device 210, suchas the illumination source of the secondary camera (as describedherein), and/or the visualization device 220, such as the illuminationsource of the primary camera (as described herein), The insertion device210 and/or the visualization device 220 can receive light from one ormore external light source(s), such as from the patient cart 104 via oneor more cables illustrated in FIGS. 1A-1B, or light source(s) internalto the insertion device 210 and/or the visualization device 220.

In some cases, an illumination device (not shown) can be used tosimilarly illuminate any of the openings disclosed herein, such as 330,410, 412, or the like.

With reference to FIGS. 3B-3C, the closure 394 can be shaped as a funnelto facilitate insertion of the one or more instruments. The closure 394can have a larger opening that is proximal from the one or more openingsof the one or more instrument channels 340 than the one or more distalopenings. The closure 394 can be shaped to taper from the proximal tothe one or more distal openings, facilitating directing or guiding oneor more instruments into the one or more openings of the one or moreinstrument channels 340.

Visualization Device

FIG. 4A illustrates a front perspective view of the visualization device220 according to some embodiments. The housing 222 of the visualizationdevice can include openings 410 and 412 configured (for example, sizedand/or shaped) to permit the camera tube 224 to pass through. Asillustrated, the proximal end 224A of the camera tube 224 (illustratedfor convenience without a middle portion) can be attached to thehousing. The camera tube 224 can loop around at least the portion of thehousing 222 when the distal end 224B is inserted through one or more ofthe openings 410 and 412 (see FIG. 2A). The openings 410 and 412 can bealigned to permit the camera tube 224 to pass through. A bottom opening(not illustrated) aligned with the opening 412 can be positioned on thebottom of the housing 222 to permit the camera tube 224 to exit thehousing 222 after passing through an interior portion of the housing(such as, the interior portion illustrated in FIG. 4C). This bottomopening can be positioned adjacent to (such as over or on top of) theopening 330 in the housing of the insertion device 210 when thevisualization device 220 is positioned adjacent to and/or attached tothe insertion device. One or more of the openings 410, 412, or thebottom opening can include a seal, which may be covered by a closure(such as a latch) as described herein.

The housing 222 can include a drive opening 414. The drive opening canbe positioned on a side of the housing 222 (for example, the back of thehousing) that attaches to the mounting interface of the drive unit 106as described herein. The drive opening 414 can be configured (forexample, sized and/or shaped) to receive one or more drivers (at leastone of 232A or 232B), such as a plurality of drive rollers as describedherein (see, for example, FIG. 2A). With reference to FIG. 2A, theplurality of drive rollers can include right drive roller 232A and leftdrive roller 232B (collectively, referred to as 232). When insertedthrough the opening 410, the camera tube 224 is positioned between theright and left drive rollers 232A and 232B and contacts the driverollers. The drive rollers 232 can contact, grip, or abut the cameratube 224. The drive rollers can advance the camera tube 224 down orretract it up through the drive opening 414. Movement of the driverollers 232 in a first direction can advance the camera tube 224 forwardor down through the drive opening 414 in order to advance the distal end224B toward the site of interest. For example, the right driver roller232A can spin counterclockwise and the left drive roller 232B can spinclockwise in order to advance the camera tube 224 forward. Suchcombination of the counterclockwise and clockwise movement of the driverollers can constitute the first direction. Movement of the driverollers 232 in a second direction can retract the camera tube 224backward or up through the drive opening 414 in order to retract thedistal end 224B away from the site of interest. For example, the rightdrive roller 232A can spin clockwise and the left drive roller 232B canspin counterclockwise in order to retract the camera tube 224 backward.Such combination of the clockwise and counterclockwise movement of thedrive rollers can constitute the first direction. For each of the rightand left drive rollers, movement in the second direction can be oppositeto movement in the first direction even in cases where drive rollersspin in opposite directions during movement in the first and/or sectiondirection.

Drive rollers 232 can have an external surface that is made out ofand/or is covered by soft material, such as rubber, foam, or the like,that grips an external surface of the camera tube 224 in order to one ormore of advance or retract the camera tube. In some embodiments, aportion of the camera tube 224 positioned between the drive rollers 232can slip along the drive rollers, and as a result the camera tube wouldnot be advanced or retracted. For example, slipping can be advantageouswhen a user's limb becomes caught in the loop formed by the camera tube224 or in case of malfunction to prevent or lessen the risk of injury tothe user or damage to one or more of the camera tube 224, thevisualization device 220, the insertion device 210, or any other part ofthe system 100. At least one of one or more of the material on theexternal surface of the drive rollers 232 or on an external surface ofthe camera tube 224 or a surface pattern on the surface of one or moreof the external surface of the drive rollers 232 or the external surfaceof the camera tube 224 can be selected to have a friction coefficientthat results in slippage in case force on the camera tube exceeds amaximum force, such as, a maximum frictional force. The maximumfrictional force can depend on one or more of the friction coefficientbetween the drive rollers 232 and camera tube 224 or a clamping forcebetween the drive rollers 232 and camera tube 224. In some cases, themaximum frictional force can be 5 N or less or more, 7 N or less ormore, 10 N or less or more, or the like. Surface pattern on the externalsurface of the drive rollers 232 (and/or the external surface of thecamera tube 224) can affect the friction coefficient. For example,ribbed surface pattern, toothed surface pattern, or the like canincrease the friction coefficient compared to a smooth or substantiallysmooth surface pattern.

At least a portion of the distal end 224B of the camera tube 224 canarticulate to permit viewing of at least a portion of the site ofinterest. The housing 222 can include one or more actuators 420configured to control movement of the distal end 224B of the camera tube224, which can include one or more cameras. In some cases, a firstactuator can control pitch or tilt (up/down movement) of the distal end224B, and a second actuator can control yaw or pan (left/right movement)of the distal end 224B. The first and second actuators can controlmovement of the distal end 224B by manipulating links positioned in theinterior of the camera tube 224 as described herein (for example, withreference to FIGS. 4B-4C).

The housing 222 can include one or more attachment mechanisms 428. Forexample, the one or more attachment mechanisms 428 can be buttonspositioned on opposite sides of the housing 222. The buttons can beconfigured to removably attach the visualization device 220 to themounting interface of the drive unit 106 (or, in some cases,additionally or alternatively to the housing 212 of the insertion device210). Pushing the buttons can release the insertion device 210 from themounting interface (and/or the housing 212). The one or more attachmentmechanisms 428 can permit attachment to and release of the visualizationdevice 220 from one or more supporting rods or pins (and/or the housing212). As described herein, the one or more attachment mechanisms 428 canactivate or release a lock, such as a cam lock, cam lock with spring, orthe like. The housing 222 can include one or more openings 424 forreceiving one or more the supporting pins that can be positioned on themounting interface.

FIG. 4B illustrates a perspective view of the distal end 224B of thecamera tube 224 according to some embodiments. An imager 430 (which canbe the primary camera) with one or more cameras can be positioned at ornear the tip of the distal end 224B. The distal end 224B can include apitch or tilt segment or section 442 for controlling up/down movement ofthe distal end 224B, and a yaw or pan segment section 444 forcontrolling left/right movement of the distal end 224B. As illustrated,the tilt section 442 can be positioned adjacent the imager 430, and thepan section 444 can be positioned adjacent to the tilt section. Pansection 444 can be positioned farther away from the tip of the distalend 224B than the tilt section 442. In some cases, positioning of thesections 442 and 444 relative to the tip can be reversed. In some cases,the sections 442 and 444 can be intermingled with respective couplingsor guides (as described below) of the sections 442 and 444 alternating.

At least one of sections 442 or 444 can include one or more couplings orguides 434. The one or more couplings 434 can be coupled to each otherto allow bending of the distal end 224B. The sections 442 and 444 canbend (as described herein) as a result of at least one of pulling orpushing one or more flexible or substantially flexible links 448positioned in the interior of the camera tube 224 that control, forexample, the bend, curvature, or another aspect of spatial orientationof one or more of sections 442 or 444. One or more links 448 can includea wire, cable, or the like with elasticity that can support at least oneof tension or compression without permanent deformation. One or morelinks 448 can be connected to the one or more guides 434 (for example,by being connected to the one or more guides in the interior of thecamera tube 224). Movement, such as pulling and/or pushing, of the oneor more links 448 can cause adjustment of the spatial orientation of theone or more guides 434 and, as a result, one or more sections 442 or444.

As described herein, one or more actuators 420 can pull and/or push theone or more links 448, for example, via rotation in first and/or seconddirections. Pulling a link 448 can cause shortening its length, whilepushing the link can cause lengthening the link (such as, returning thelink substantially to its initial length).

Segment or section 446 can be positioned adjacent the pan section 444 atthe distal end 224B of the camera tube 224. As described herein, section446 can be flexible or substantially flexible. One or more of sections442 or 444 can be rigid or substantially rigid to prevent at least theimager 430 of the distal end 224B from drooping or sagging as the distalend 224B exits the channel 320 of the insertion device. Drooping orsagging can undesirably lead to at least a temporary loss of vision ofat least a part of the site of interest or inadvertent contact withtissue near or outside the site of interest. Rigidity of the one or moresections 442 or 444 can prevent movement of the distal end 224B in adownward direction (for example, in the absence of actively tilting thecamera tube 224 as described herein), while permitting movement in theopposite direction as the camera tube 224 is passed through one or moreopenings or channels, as described herein. Rigidity can help maintainorientation of at least the imager 430 in same plane of the channel 320or in a plane above the plane of the channel 320 as the distal end 224Bof the camera tube 224 exits the channel 320. The latter plane can beparallel or substantially parallel to the plane of the channel 320.

In some cases, to increase the rigidity of the distal end 224B, asupporting material or mechanism may be added to the distal end 224B tohelp maintain orientation of at least the imager 430 in the same planeof the channel 320. Such design can prevent the camera from droopingand/or contacting unwanted areas of the site of interest. The supportingmaterial or mechanism can allow the distal end 224B to flex (or curve)in one direction in a plane while preventing other flexing (or curving),thereby allowing the distal end 224B to move through a curved portion ofthe interior passage 322 of the housing 212. With reference to FIG. 3E,for instance, flexing in the direction of the bend or curve of theinterior passage 322 can be permitted, while flexing in the otherdirection may not be permitted.

FIG. 4C illustrates a cross-sectional view of the housing 222 and cameratube 224 of the visualization device 220 according to some embodiments.The figure depicts view of an interior portion of the housing 222looking up through the opening 412 in the housing 222. Proximal end 224Aof the camera tube 224 can be attached to the housing 222 as describedherein. As illustrated, interior of the proximal end 224A can includeone or more links 448 that extend along the length of the camera tube224 to the distal end 224B, as described herein. In use, the camera tube224 passes through the interior portion illustrated in FIG. 4C.

The one or more actuators 420 can include first and second actuatorsthat, respectively, control tilting or panning of the distal end 224B ofthe camera tube 224. For example, the first actuator can control pullingand/or pushing of one or more links 448 connected to a plurality ofguides in the tilt section 442. The first actuator can control tiltingup/down of at least the imager 430. The second actuator can controlpulling and/or pushing of one or more links 448 connected to a pluralityof guides in the pan section 444. The second actuator can controlleft/right movement of at least one of the tilt section 442 and/or theimager 430.

Pulling and/or pushing at least one link 448 can be performed viaactuating the first and/or second actuator 420. With reference to thefirst actuator, for instance, its exterior portion that protrudes fromthe housing 222 can serve as a shaft connected to a drum 450 located inthe interior of the housing 222. Rotation of the shaft and drum cancause a corresponding link pulley 460 to rotate, for example, in a planeperpendicular to the plan of rotation of the shaft and drum. The pulley460 can be connected to the drum 450 such that rotation of the drumcauses the pulley to rotate. The drum 450 can have threading on thesurface that contact threading on the surface of the pulley 460 andtransfers rotation to the pulley. The pulley 460 can be connected to atleast one link 448. For instance, the at least one link can be attachedto the pulley. Rotation of the actuator 420 in a first direction (forexample, clockwise) can cause rotation of the corresponding shaft (forexample, in the same clockwise direction). This can cause thecorresponding pulley 460 to rotate and, for instance, pull (or push) theassociated at least one link, which can cause tilting of at least theimager 430. In some cases, the pulley 460 can be connected to a pair oflinks 448 one of which is pulled while the other is pushed to controlthe tilting. Second actuator can operate similarly to control thepanning.

Additional details of controlling one or more of the tilt or pan of thedistal end 224B of the camera tube are similar to those described inU.S. Patent Publication No. 2016/0143633 and U.S. Pat. No. 9,629,688,which are assigned to the assignee of the present application and thedisclosure of each of which is incorporated by reference in itsentirety.

Mounting Interface and Sterile Barrier

FIG. 5A illustrates the drive unit 106 of the robotic surgery system 100according to some embodiments. The drive unit 106 can include a mountinginterface 500 configured to support one or more of the insertion device210 or visualization device 220. The mounting interface can include anopening or slit 504 for receiving a looped portion of the camera tube224 (see, for example, FIG. 6I).

FIG. 5B illustrates a perspective view of the mounting interface 500according to some embodiments. The mounting interface 500 can includeone or more posts or pins 510 configured to actuate one or more drivers232 for moving the camera tube 224 as described herein. As illustrated,the pins 510 can be provided to support the rollers 232A and 232B. Thepins 510 can be configured (for example, sized and/or shaped) to attachto the rollers 232A and 232B. For example, the pins 510 can behexagonal, and the rollers 232A and 232B can include hexagonal openings(see, for example, FIG. 5D) configured (for example, sized and/orshaped) to be mounted on the hexagonal surface of the pins 510. In somecases, one or more shapes such as square, round, triangular, or the likecan be used in addition to or instead of hexagonal.

The mounting interface 500 can include one or more actuators 520 forcausing movement of the one or more actuators 420 of the visualizationdevice 220. As illustrated, two actuators 520 can be provided, and theycan include shafts or recesses configured (for example, sized and/orshaped) to receive protruding exterior portions of the actuators 420.Within the recesses, the actuators 520 can include surfaces configured(for example, sized and/or shaped) to mate with the surfaces of theprotruding exterior portions of the actuators 420. The mating canprovide attachment of the actuators 420 of the visualization device 220to the actuators 520 of the mounting interface 500.

As described herein, the mounting interface 500 can support one or moreof the insertion device 210 or visualization device 220. As illustratedin FIG. 5B, the visualization device 220 can be at least partiallysupported by the pins 510 supporting the drivers 232 that are placed inthe recess 414 of the housing 222. The mounting interface 500 caninclude one or more pins 530 configured to support the insertion device210. The one or more pins 530 can be configured (for example, sizedand/or shaped) to be received in the one or more openings 350 of theinsertion device 210. The one or more pins can have size, shape, and/orsurface pattern configured to be attached to insertion device 210. Forexample, as is illustrated, a left pin 530 can have a groove, pattern,or indentation 552 at or near its tip. The indentation 552 can beconfigured (for example, sized and/or shaped) to mate with a surface inthe interior of the left opening 350 (see, for example, FIG. 3B. Thiscan provide attachment of the insertion device 210 to the mountinginterface 500. As described herein, one or more attachment mechanisms360 can operate to disengage the visualization device 210 from themounting interface 500. For example, one or more attachment mechanisms360 can be pressed to disengage mating of the surface in the interior ofthe left opening 350 with the indentation 552. The right pin 530 canhave a similar groove, pattern, or indentation 552 at its tip on theside facing the left pin.

FIG. 5C illustrates a rear view of the mounting interface 500 accordingto some embodiments. The mounting interface can include a first set ofactuators 532, a first set of gears 534 connected to or attached to thefirst set of actuators 532, and a second set of gears 536 cooperatingwith the first set of gears 534. These components can be collectivelyconfigured to actuate the one or more pins 510. As illustrated, thefirst set of actuators 532 can include two actuators, the first set ofgears 534 can include two gears, and the second set of gears 536 caninclude two gears. In some cases, the first set of actuators can bemotors, for example, electric motors.

The first set of gears 534 can interlock with the second set of gears536. In some cases, the first set of actuators 532 can be configured torotate the first set of gears 534 attached to the first set of actuators532. Rotation of the first set of gears 534 can cause the second set ofgears 536 to rotate in a plane perpendicular to the plane of rotation ofthe first set of gears 534. The one or more pins 510 can be connected orattached to the second set of gears 536. Rotation of the second set ofgears 536 can cause rotation of the one or more pins 510. Rotation ofthe one or more pins 510 can cause rotation of the one or more drivers232 and movement of the camera tube 224, as described herein. Rotationof the one or more pins 510 and one or more drivers 232 can be in thefirst and/or second direction to advance and/or retract the camera tube224, as described herein. Rotation in the first and/or second directioncan be caused by movement of the one or more actuators in at least twodirections (for example, clockwise or counterclockwise).

The mounting interface 500 can include a second set of actuators 542, athird set of gears 544 connected to or attached to the second set ofactuators 542, and a fourth set of gears 546 cooperating with the thirdset of gears 544. Collectively these components can be configured toactuate the one or more actuators 520. As illustrated, the second set ofactuators 542 can include two actuators, the third set of gears 544 caninclude two gears, and the fourth set of gears 546 can include twogears. In some cases, the first set of actuators can be motors, forexample, electric motors.

The second set of actuators 542, third set of gears 544, and fourth setof gears 546 can cooperate with each other and operate to actuate theone or more actuators 520 similarly to the foregoing description ofactuating the one or more pins 510. As described herein, movement of theactuators 520 and corresponding movement of the actuators 420 of thevisualization device 220 can cause the camera tube 224 to tilt and/orpan.

FIG. 5D illustrates the mounting interface 500 prepared for supportingone or more of the insertion device 210 or visualization device 220according to some embodiments. In some implementations, a sterilebarrier may need to be provided between the mounting interface 500 ofnon-sterile drive unit 106 and the insertion device 210 and/or sterilevisualization device 220. The insertion and visualization devices, 210and 220, may be required to be sterile in order to protect the site ofinterest from infection in case of one or more of the insertion orvisualization device coming into contact with the site of interest orwith another sterile component of the system 100 (such as, aninstrument) that may come into contact with the site of interest, with auser performing or assisting with the surgery.

One or more drivers 232 (for example, rollers) can be sterile and can beattached to or mounted on the one or more pins 510 of non-sterilemounting interface 500. A sterile cover 550 can be attached to ormounted to cover the one or more pins 530. With reference to FIG. 5B,the cover 550 can be mounted in a region 560 on a front surface of themounting interface 500. The cover 550 can be secured with one or moreclosures (not illustrated). For example, the one or more closures can bepins that are pushed in by the cover 550 when it is mounted in theregion 560. Pushing of the pins can cause a closure, such as a latch, tobecome closed. The cover 550 can be removed from the region 560, forexample, by pressing a button positioned on the bottom surface of themounting interface 500 (not shown), which can push the pins against thecover 550 and dislodge the cover.

The cover 550 can include a bottom set of pin covers for covering theone or more pins 530. The cover 550 can include a top set of pins 540that can be configured to support the visualization device 220 when itis attached to the mounting interface 500. The set of pins 540 can besized and/or shaped to be received in the one or more openings 424 ofthe visualization device 220. The set of pins 540 can have size, shape,and/or surface shape configured to be attached to the visualizationdevice 220, for example, as described herein in connection with the pins530.

With reference to FIG. 5E, in some implementations, the mountinginterface 500 can include one or more pins 530′ configured (for example,sized and/or shaped) to support the visualization device 220. Forexample, the one or more pins 530′ can function similar to the one ormore pins 540. One or more pins 530′ can be covered by the cover 550,such as by pin covers 540. In some cases, as illustrated in FIG. 5E,individual covers 550′ can be used to cover each of the one or more pins530 and/or 430′. In some embodiments, two separate covers can be used tocover the one or more pins 530 and 430′ respectively. In someimplementations, a single cover 550 (as illustrated in FIG. 5D) but withpin covers replacing the top set of pins 540 can be used to cover theone or more pins 530 and 530′.

In some cases, a sterile barrier can be formed between one or moreactuators 420 of the visualization device (see, for example, FIG. 4A)and one or more actuators 520 of the mounting interface (see forexample, FIG. 5B) in one or more of the following ways. One or moreactuators 420 can be covered by one or more sterile covers as describedherein. A sterile drape can be placed over the drive unit 106 and themounting interface. Drape material can flex and/or slip to provide thesterile barrier. Drape material can have appropriate thickness and/orother properties to allow for the flexing and/or slippage. The drape caninclude one or more sterile covers (which can function as actuators)that transfer motion between the one or more actuators 420 and one ormore actuators 520. The one or more sterile covers can be embedded orintegrated into the drape.

The one or more drivers 232 and one or more covers 550 can serve as atleast a partial sterile barrier between the mounting interface 500 andthe insertion and visualization devices and the camera tube 224. Any oneor more of the drivers 232, one or more of the covers 550, or any othersterile barriers disclosed herein can be disposable or can be reusedafter being sterilized. For example, the one or more sterile covers 550can be made out of plastic and be disposable. As another example,rollers 232A and 232B can be disposable.

Any of the sterile components described herein can be sterilized byfluid or gas (such as ethylene oxide (EtO)), heat (such as autoclaving),irradiation (such as gamma irradiation), or the like. For example, theone or more openings in the insertion device 210 and/or visualizationdevice 220 can facilitate fluid or gas to contact exterior and interiorsurfaces during sterilization.

Docking the Insertion and Visualization Devices

FIG. 6A illustrates the insertion device 210, visualization device 220,one or more covers 550, drivers (such as rollers) 232A and 232B, and themounting interface 500 of the drive unit 106 according to someembodiments. As illustrated in FIG. 6B, a sterile drape 600 can beplaced over drive unit 106 (and, in some cases, other parts of therobotic surgery system) to provide additional or alternative sterilebarrier. For example, the drape 600 can act as a sterile barrierpermitting a user performing or assisting with the surgery to touch thedrive unit 106. One or more holes 610 can be made in the drape 600 topermit one or more pins 510, 530, and/or 540 or 530′ to be accessed.Positions and sizes of the one or more holes 610 can correspond topositions and sizes of the one or more pins. The drape 600 can be pulledtight around the drive unit 106 and other components of the system 100as illustrated in FIG. 6C. The drape 600 can be held in place with oneor more of ties, adhesive attachments, magnetic attachments, or thelike.

The drivers 232A and 232B can be mounted on the one or more pins 510 asillustrated in FIG. 6D and described herein. The one or more pins 510can be exposed through corresponding one or more holes 610 in the drape600. One or more covers 550 can be mounted on one or more pins 530and/or 530′ as illustrated in FIG. 6E and described herein. The one ormore pins 530 and/or 530′ can be exposed through corresponding one ormore holes 610 in the drape 600.

The visualization device 220 can be mounted on (or docked to) themounting interface 500 as illustrated in FIG. 6F and described herein.The camera tube 224 (which can be sterile) can be inserted into thevisualization device 220 as described herein. At least a portion of theloop of the camera tube 224 can be positioned in the slit 504 as shown.The drape 600 can include enough slack to allow the camera tube 224 andsurrounding drape material to be placed in the slit 504. In some cases,the drape 600 can include a portion shaped to generally correspond withthe slit 504 to facilitate positioning of the portion of the loop of thecamera tube 224 in the slit 504.

The insertion device 210 can be mounted on (or docked to) the mountinginterface 500 as illustrated in FIG. 6G and described herein. In somecases, the insertion device 210 may have already been placed near orinto the site of interest prior to being mounted on the mountinginterface 500. In such cases, the drive unit 106 can be brought towardthe insertion device 210 for docking the insertion device. The order ofthe mountings (or connections or dockings) can be interchanged. Forexample, the visualization device 220 can be mounted on the mountinginterface 500 after the drive unit 106 has been docked with theinsertion device 210. The visualization device 220 and insertion device210 can be independent from each other (for example, modular) so thatthe visualization device 220 can be changed during surgery if it breaksdown or otherwise becomes unresponsive without the need to first undockthe insertion device 210 (and any instruments which may have been placedthrough the insertion device).

Camera tube 224 can be advanced though the visualization device 220 andinserted into the interior of the insertion device 210 as illustrated inFIG. 6H and described herein. Camera tube 224 can be further advancedthrough the interior of the insertion device 210 so that the distal end224B exits the insertion device 210 as illustrated in FIG. 6I anddescribed herein. The distal end 224B of the camera tube 224 can beadvanced near or into the site of interest. Then, one or moreinstruments (which can be sterile) can be inserted and advanced near orinto the site of interest.

In some cases, a user, such as a nurse, can insert one or moreinstruments, dock one or more of the visualization device or insertiondevice on the mounting interface 500, and advance and/or retract thecamera tube 224. A surgeon operating the robotic surgical system 100 cancause the camera tube 224 to be advanced and/or retracted. For example,the surgeon can operate the camera tube 224 once the distal end 224B ofthe camera tube has been inserted into the opening 410 and past opening412.

Operation of a Visualization Device

As described herein, the visualization device 220 can include an imager,such as the imager 430 illustrated in FIG. 4B. The imager can bepositioned at or near the tip of the distal end 224B of the camera tube224. As described below, the imager can be oriented in various positionsin the camera tube 224.

FIG. 7A illustrates a combination 700A of an image module or imager 702,which can be similar to the imager 430, and a proximal end 750 of theinsertion device 210. The imager 702 can include one or more cameras 710and one or more illumination channels 720 in which one or moreillumination devices can be positioned. The one or more illuminationsources or devices can illuminate at least a portion of the site ofinterest to permit viewing of the at least one portion. The one or moreillumination devices can include one or more light sources, such aslight emitting diodes (LEDs), optical fiber(s), or the like. Asillustrated, in some cases, two (or more) cameras 710 can be used inorder for the imager 702 to operate as a stereoscopic imager, and toproduce three-dimensional representation of at least a portion of thesite of interest. Each of the cameras 710 can include one or more lenses730 that focus light from and/or reflected by at least the portion ofthe site of interest on an image sensor 740. The one or more lenses 730can include concave and/or convex lenses. In some cases, one or morelenses 730 can be moved to adjust the zoom (such as, an optical zoom).The image sensor 740 can detect the light and convert it to imageinformation or data. For instance, the image sensor 740 can measurebrightness at a plurality of points. The image sensor 740 can include atleast one of charge-coupled devices (CCDs), complementarymetal-oxide-semiconductor (CMOS) image sensors, or the like. The imagesensor 740 can be a digital and/or analog image sensor. In someimplementations, one camera 710 can be used or more than two cameras canbe used.

The imager 702 can be positioned in the camera tube 224, such as at ornear the tip of the distal end 224B of the camera tube. For example, theimager 702 can be at least partially inserted into the camera tube 224.As illustrated in FIG. 7A and described herein, the camera tube 224 withthe distal end 224B can be inserted in a channel of the plurality ofchannels 214 of the insertion device 210. As described herein, suchchannel can be the channel 320. A protector 760 (such as glass orplastic) can be positioned in the camera tube 224 closer to the tip thanthe imager 702. The protector 760 can protect the imager 702 frombreaking or malfunctions due to, for example, coming into contact withfluid in the site of interest. The imager 702 can serve as the primarycamera as described herein. A secondary camera can be positioned in thechannel 310 as described herein.

In some cases, the imager 702 can be included inside an imaging module(not shown) that may be hermetically sealed and that is coupled orotherwise mounted to the distal end 224B of the camera tube. The imagingmodule enclosing the imager 702 could be removably mounted and allow theability to have the imaging module and camera tube 224 manufacturedand/or packaged at separate locations. A variety of imaging modules (forexample, with different orientations) can be provided as describedherein.

Different orientations of the imager 702 in the camera tube 224 of thevisualization device 220 can provide different advantages for exploringthe site of interest. In some embodiments, the imager 702 can bepositioned along or substantially along a central axis 792 of the distalend 224B of the camera tube 224 as illustrated in an arrangement 700B ofFIG. 7B. In such orientation, the imager is not tilted down or up withrespect to the distal end 224B of the camera tube when the proximal endis extended away from the insertion device 210 toward the site ofinterest. A field of view 770 of the imager 702, which can represent anarea or region in which the imager obtains or captures image data, canbe oriented along or substantially along the central axis 792. The fieldof view 770 can encompass a region straight ahead of the distal end 224Bof the camera tube 224.

Advantageously, in some cases, the imager 702 of the arrangement 700Bcan provide image data of at least a portion of the site of interestwhen the site is positioned in front of the insertion device 210. Forexample, the imager 702 can “look straight ahead” or provide image dataof a region in front as the distal end 224B of the camera tube 224 exitsthe channel of the insertion device 210. When the insertion device 210is positioned adjacent the site of interest, imager positioning in thearrangement 700B can permit viewing the site of interest. This can beimportant, for example, to facilitate safe insertion of at least aportion of the distal end 224B (along with, for example, the primarycamera) into the site of interest.

In some cases, the one or more instrument channels 340 are positionedbelow the channel 320 through which the distal end 224B of the cameratube 224 is passed. With reference to FIG. 7C, when one or moreinstruments are inserted through one or more instrument channels 340, itmay be desirable to orient the imager 702 of the arrangement 700B toobtain a field of view oriented at least partially downward. Forexample, the imager 702 can be positioned to “look down” at the one ormore instruments. Orienting the field of view 770 at least partiallydownward can advantageously permit viewing of the insertion of one ormore instruments 758 into the site of interest. This can facilitate safeinsertion of the one or more instruments into the site of interest.

As illustrated in FIG. 7C, in order to orient the field of view 770 atleast partially downward, the distal end 224B of the camera tube 224 maybe bent along a plurality of segments or sections 762B and 764B. Asdescribed herein, section 764B can correspond to the tilt section 442,and section 762B can correspond to the pan section 444. Both sections762B and 764B may be bent to orient the imager 702 to provide image datarelating to the position of the one or more instruments 758.

FIG. 7D illustrates an arrangement 700D in which the imager 702 istilted downward at an angle θ relative to the central axis 792. Theangle θ is formed between the central axis 792 and a central axis 794 ofthe imager 702. The angle θ can be 10 degrees or less or more, 15degrees or less or more, 20 degrees or less or more, or the like.Tilting the imager 702 downward can cause the field of view 770 to beoriented at least partially downward. Advantageously, the field of view770 can capture at least a portion of the region in front (which, forexample, can be the site of interest as described herein) as well as atleast a portion of the region below the imager 702. The arrangement 700Dcan permit viewing of the position of the one or more instruments 758 aswell as viewing of at least the portion of the site of interest. Thiscan facilitate insertion of both the primary camera and the one or moreinstruments 758.

As illustrated in FIG. 7E, the field of view 770 in the arrangement 700Dcan be further oriented downward by bending the distal end 224B of thecamera tube 224 along a plurality of segments or sections 762D and 764D.These sections can be similar to sections 762B and 764B of thearrangement 700B (shown in FIG. 7C), respectively. The angle orcurvature of the bend in at least one of the sections 762D and 764D canbe smaller than in at least one of the sections 762B and 764B,respectively. This reduction can be due to initially tilting the imager702 downward at the angle θ.

FIG. 7F illustrates an arrangement 700F in which the imager 702 ispositioned downward at approximately 90 degree angle relative to thecentral axis 792. The field of view 770 captures a region below theimager 702. This can be advantageous to facilitate insertion of the oneor more instruments 758. The field of view 770 may not capture orsubstantially not capture at least a portion of the region in front ofthe imager 702. In order to capture at least the portion of this region,the distal end 224B of the camera tube 224 can be bent along a segmentor section 762F as illustrated in FIG. 7G. This orientation canfacilitate insertion of the primary camera. Comparing with thearrangements 700B and 700D, adjustment of the orientation of a singlesegment 762F may be sufficient.

As illustrated in arrangement 700H of FIG. 7H, in order to capture atleast a portion of a region behind the imager 702, the distal end 224Bof the camera tube 224 may be bent along a plurality of segments orsections 762H and 764H. These sections can similar to sections 762B and764B of the arrangement 700B, respectively. The field of view 770 of thearrangement 700H can permit viewing of the one or more instruments 758being advanced through the one or more instrument channels in theinsertion device 210.

In some cases, a second or another imager can be provided in thearrangement 700F, in which the imager 702 is positioned substantiallydownward. For example as illustrated in FIG. 8 , such second imager 802can be positioned along or substantially along the central axis of thedistal end 224B of the camera tube 224 similarly to the arrangement700B. The second imager 802 can provide an additional field of view 870to the field of view 770 of the imager 702. The field of view 870 cancapture at least a portion of the region in front of the second imager802. This can facilitate insertion of the primary camera, which caninclude both imagers 702 and 802.

In some implementations, the imager 702 can be tilted up. For example,this can be advantageous when one or more instrument channels throughwhich one or more instruments are inserted are positioned above thechannel 320 through which the distal end 224B of the camera tube 224 ispassed.

As described herein, the imager 702 can be oriented differently relativeto the central axis 792 of the distal end 224B of the camera tube 224.The imager 702 can be positioned substantially along the central axis792, perpendicular to the central axis, or at any angle between 0degrees and 90 degrees (facing up or down) relative to the central axis.Varying the orientation of the imager 702 can adjust the orientation ofthe field of view 770 of the imager. A suitable orientation of theimager 702 can be selected based on a desired field of view 770.

In some cases, one or more actuators configured to adjust orientation ofthe imager 702 can be provided. For example, the one or more actuatorscan include one or more motors. Advantageously, orientation of theimager 702 can be adjusted in operation.

Movement of Primary Camera

Oher mechanisms for advancing and/or retracting a camera tube can beused. In some cases, a movement device can travel along with the cameratube. For example, FIGS. 9A-9B illustrate an insertion and/orvisualization device 920 with a movement device 930 configured to travelvertically (or, in some cases, horizontally) to advance and/or retract acamera tube 924. FIG. 9A illustrates a distal end 924B of the cameratube 924 extending at a maximum distance toward the site of interest(such as, fully extended). In this position, the movement device 930 ismoved downward, such as to the bottom position in a housing 922, toadvance the distal end 924B. FIG. 9B illustrates the distal end 924B ofthe camera tube 924 extending at a maximum distance away from the siteof interest (such as, fully retracted). In this position, the movementdevice 930 is moved upward, such as to the top position in the housing922, to retract the distal end 924B.

The movement device 930 can include one or more actuators (for example,one or more motors) that move the movement device up and/or down (or, insome cases, left and/or right) within the housing 922. For example, themovement device 930 can move along a rail or post 940. In some cases,the rail 940 can include a chain for facilitating or guiding movement ofthe movement device. The movement device can include additional one ormore actuators configured to tilt and/or pan one or more cameraspositioned in the camera tube 924.

As illustrated in FIGS. 10A-10B, a movement device 1030 may bepositioned outside and/or away from a housing of an insertion and/orvisualization device 1020. The movement device 1030 can move downward toadvance a distal end 1024B of a camera tube toward the site of interest.The movement device 1030 can move upward to retract the distal end1024B. As illustrated, the movement device 1030 can downward and/orupward at an angle to the vertical axis.

In some cases, a movement device can be substantially stationary and thecamera tube may not form a loop as described herein. For example, FIG.11 illustrates a drive unit 1106 supporting (for example, on top) amovement device 1130 configured to advance and/or retract a camera tube1124 that includes a proximal end 1124A and a distal end 1124B. Themovement device 1130 can advance and/or retract the distal end 1124B ofthe camera tube 1124 along substantially horizontal direction (or, insome cases, a vertical direction). The proximal end 1124A of the cameratube 1124 can provide “slack” or sufficient camera tube length toadvance the distal end 1124B to a maximum distance toward the site ofinterest (or away from the drive unit 1106). In some cases, the movementdevice 1130 can be positioned at another location on the drive unit 1106or be supported by another component of a robotic surgery system.

In some cases, at least a portion of the camera tube can besubstantially rigid. For example, FIG. 12A illustrates perspective viewof a movement device 1230 supported by a drive unit 1206. The movementdevice 1230 can be positioned at the rear of the drive unit 1206. Themovement device 1230 can be configured to advance and/or retract acamera tube 1224 that includes a proximal end 1224A and a distal end1224B. FIG. 12B illustrates a bottom view showing one or more openings1240 for one or more instruments (not shown). In operation, the one ormore instruments can be positioned adjacent to the camera tube 1224. Insome cases, the movement device 1230 can be positioned at anotherlocation on the drive unit 1206 or be supported by another component ofa robotic surgery system.

FIG. 12C illustrates the camera tube extending at maximum distance awayfrom the site of interest (such as, fully retracted). In this position,a movement portion or mover 1232 can be fully retracted. For example,the mover 1232 can retracted backward and oriented outside an interiorportion of the drive unit 1206. Movement of the mover 1232 can cause themovement device 1230 to move in the same direction. The camera tube 1224can be attached or connected to the movement device 1230, and movementof the movement device 1230 can cause the camera tube 1224 to move inthe same direction. Also illustrated are one or more actuators 1220configured to control tilt and/or pan of one or more cameras positionedin the camera tube 1224. FIG. 12D illustrates the camera tube extendingat maximum distance toward the site of interest (such as, fullyextended). In this position, the mover 1232 can be fully extended. Forexample, the mover 1232 can be extended forward and oriented in theinterior portion of the drive unit 1206. As described, at least aportion of the camera tube 1224 can be substantially rigid at leastbecause the proximal end 1224A may be maintained as substantiallystraight. For instance, the proximal end 1224A may not be bent incontrast with, for example, in FIG. 11 ). The proximal end 1224A caninclude the substantially rigid portion. Advantageously, having thesubstantially rigid portion may prevent the camera tube 1224 coming intocontact with unsterile surface or object, such as the floor, because ofthe length of the slack.

Advantageously, using a visualization device configured to cause thecamera tube to form a loop as described herein can reduce or eliminatethe risk of a camera tube coming into contact with an unsterile surfaceor object. Advantageously, drivers configured to rotate (such as,rollers) to advance/retract the camera tube as described herein canfacilitate reducing the size of a visualization device.

OTHER VARIATIONS

Those skilled in the art will appreciate that, in some embodiments,additional components and/or steps can be utilized, and disclosedcomponents and/or steps can be combined or omitted. For example,although some embodiments are described in connection with a roboticsurgery system, the disclosure is not so limited. Systems, devices, andmethods described herein can be applicable to medical procedures ingeneral, among other uses. As another example, certain components can beillustrated and/or described as being circular or cylindrical. In someimplementations, the components can be additionally or alternativelyinclude non-circular portions, such as portions having straight lines.As yet another example, any of the actuators described herein caninclude one or more motors, such as electrical motors. As yet anotherexample, in addition to or instead of controlling tilt and/or pan of acamera, roll (or spin) can be controlled. For example, one or moreactuators can be provided for controlling the spin.

The foregoing description details certain embodiments of the systems,devices, and methods disclosed herein. It will be appreciated, however,that no matter how detailed the foregoing appears in text, the systems,devices, and methods can be practiced in many ways. The use ofparticular terminology when describing certain features or aspects ofthe disclosure should not be taken to imply that the terminology isbeing redefined herein to be restricted to including any specificcharacteristics of the features or aspects of the technology with whichthat terminology is associated.

It will be appreciated by those skilled in the art that variousmodifications and changes can be made without departing from the scopeof the described technology. Such modifications and changes are intendedto fall within the scope of the embodiments. It will also be appreciatedby those of skill in the art that parts included in one embodiment areinterchangeable with other embodiments; one or more parts from adepicted embodiment can be included with other depicted embodiments inany combination. For example, any of the various components describedherein and/or depicted in the figures can be combined, interchanged, orexcluded from other embodiments.

With respect to the use of substantially any plural and/or singularterms herein, those having skill in the art can translate from theplural to the singular and/or from the singular to the plural as isappropriate to the context and/or application. The varioussingular/plural permutations can be expressly set forth herein for sakeof clarity.

Directional terms used herein (for example, top, bottom, side, up, down,inward, outward, etc.) are generally used with reference to theorientation or perspective shown in the figures and are not intended tobe limiting. For example, positioning “above” described herein can referto positioning below or on one of sides. Thus, features described asbeing “above” may be included below, on one of sides, or the like.

It will be understood by those within the art that, in general, termsused herein are generally intended as “open” terms (for example, theterm “including” should be interpreted as “including but not limitedto,” the term “having” should be interpreted as “having at least,” theterm “includes” should be interpreted as “includes but is not limitedto,” etc.). It will be further understood by those within the art thatif a specific number of an introduced claim recitation is intended, suchan intent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims can contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to embodiments containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (for example, “a” and/or “an” should typically be interpreted tomean “at least one” or “one or more”); the same holds true for the useof definite articles used to introduce claim recitations. In addition,even if a specific number of an introduced claim recitation isexplicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (for example, the bare recitation of “two recitations,” withoutother modifiers, typically means at least two recitations, or two ormore recitations).

The term “comprising” as used herein is synonymous with “including,”“containing,” or “characterized by,” and is inclusive or open-ended anddoes not exclude additional, unrecited elements or method steps.

Conditional language, such as “can,” “could,” “might,” or “may,” unlessspecifically stated otherwise, or otherwise understood within thecontext as used, is generally intended to convey that certainembodiments include, while other embodiments do not include, certainfeatures, elements, and/or steps. Thus, such conditional language is notgenerally intended to imply that features, elements, and/or steps are inany way required for one or more embodiments or that one or moreembodiments necessarily include logic for deciding, with or without userinput or prompting, whether these features, elements, and/or steps areincluded or are to be performed in any particular embodiment.

Language of degree used herein, such as the terms “approximately,”“about,” “generally,” and “substantially” as used herein represent avalue, amount, or characteristic close to the stated value, amount, orcharacteristic that still performs a desired function and/or achieves adesired result. For example, the terms “approximately”, “about”,“generally,” and “substantially” may refer to an amount that is withinless than 10% of, within less than 5% of, within less than 1% of, withinless than 0.1% of, and/or within less than 0.01% of the stated amount.

It will be further understood by those within the art that anydisjunctive word and/or phrase presenting two or more alternative terms,whether in the description, claims, or drawings, can be understood tocontemplate the possibilities of including one of the terms, either ofthe terms, or both terms. For example, the phrase “A or B” will beunderstood to include the possibilities of “A” or “B” or “A and B.”Further, the term “each,” as used herein, in addition to having itsordinary meaning, can mean any subset of a set of elements to which theterm “each” is applied.

Conjunctive language such as the phrase “at least one of X, Y, and Z,”unless specifically stated otherwise, is otherwise understood with thecontext as used in general to convey that an item, term, etc. may beeither X, Y, or Z. Thus, such conjunctive language is not generallyintended to imply that certain embodiments require the presence of atleast one of X, at least one of Y, and at least one of Z.

The above description discloses embodiments of systems, apparatuses,devices, methods, and materials of the present disclosure. Thisdisclosure is susceptible to modifications in the components, parts,elements, steps, and materials, as well as alterations in thefabrication methods and equipment. Such modifications will becomeapparent to those skilled in the art from a consideration of thisdisclosure or practice of the disclosure. Consequently, it is notintended that the disclosure be limited to the specific embodimentsdisclosed herein, but that it cover all modifications and alternativescoming within the scope and spirit of the subject matter embodied in thefollowing claims.

What is claimed is:
 1. An insertion device for a single port roboticsurgery apparatus, the insertion device comprising: a housing including:an instrument channel positioned in an interior of the housing andextending along substantially an entire length of the housing, theinstrument channel configured to removably house a surgical instrument;and an opening in a rear exterior surface of the housing, the openingproviding access to the instrument channel and configured to facilitateinsertion of the surgical instrument into the instrument channel; and anillumination device supported at least partially at the rear exteriorsurface of the housing and positioned proximal to the opening, theillumination device configured to illuminate the opening to facilitateinsertion of the surgical instrument through the opening.
 2. The deviceof claim 1, wherein the illumination device is positioned in a recess inthe rear exterior surface of the housing.
 3. The device of claim 2,wherein the recess is positioned above the opening.
 4. The device ofclaim 1, further comprising: a seal covering the opening, and a closurecovering the seal for preventing the seal from being dislodged, whereinthe seal is configured to prevent ingress of fluids or solids into theopening, and wherein the closure comprises substantially transparentmaterial that permits viewing of the opening when illumination isprovided by the illumination device.
 5. The device of claim 4, whereinthe closure comprises an opening configured to permit access to anopening in the seal, the opening in the closure being tapered in adirection toward the opening in the rear exterior surface of thehousing.
 6. The device of claim 5, wherein the opening in the closureincludes a proximal end with a larger opening than an opening in adistal end.
 7. The device of claim 4, wherein the closure is removableto facilitate removal and replacement of the seal.
 8. The device ofclaim 1, wherein the housing further includes: a camera channelenclosing a camera; and a light source configured to provideillumination for the camera.
 9. The device of claim 8, wherein the lightsource comprises at least one of an optical fiber or a light emittingdiode (LED).
 10. The device of claim 8, wherein the illumination deviceutilizes the light source.
 11. The device of claim 8, wherein theillumination device comprises a light source separate from the lightsource configured to provide illumination for the camera.
 12. The deviceof claim 11, wherein the separate light source comprises an LEDpositioned in a recess in the housing.
 13. An insertion device for asingle port robotic surgery apparatus, the insertion device comprising:a housing including: a plurality of instrument channels positioned in aninterior of the housing and extending along substantially an entirelength of the housing, each instrument channel being configured toremovably house a surgical instrument; and an opening in a rear exteriorsurface of the housing, the opening providing access to the plurality ofinstrument channels and configured to facilitate insertion of thesurgical instrument into a selected one of the plurality of instrumentchannels; and an illumination device supported at least partially at therear exterior surface of the housing and positioned proximal to theopening, the illumination device configured to illuminate the opening tofacilitate insertion of the surgical instrument through the opening.